Different causes of death

Peek at the chart, and you’ll notice deaths from some illnesses that might only ring a bell from episodes of “Dr. Quinn, Medicine Woman.” People don’t really die from diptheria anymore: There’s a vaccine for it, it’s treatable with an antitoxin and antibiotics, and fewer than five cases were reported to the Centers for Disease Control and Prevention in the last decade. While tuberculosis is still around, it’s no longer a leading cause of death. In 2018, no doctor would write “diseases of insane” on a death certificate today.

Causes of death in Minnesota, 1888

15,018 people died in Minnesota in 1888, according to a chart in the Minnesota Historical Society's archives. The most common causes of death were tuberculosis, old age and infantile debility.

Source: Minnesota Historical Society

In 2018, Minnesotans die from a different lineup of illnesses. Compared to 1888, when the most common causes of death were tuberculosis, old age, infantile debility, a term for failure to thrive, and childhood diarrheal illnesses, today’s biggest killers of Minnesotans are cancer, heart disease, unintentional injury and chronic lower respiratory disease, according to 2016 data from the Minnesota Department of Health.

Causes of death in Minnesota, 2016

43,050 people died in Minnesota in 2016, according to the Minnesota Department of Health. The most common causes of death were cancer, heart disease and unintentional injury.

Source: Minnesota Department of Health

The stark difference between the two is due to a few factors, said Dr. W. Bruce Fye, emeritus professor of medicine and the history of medicine at the Mayo Clinic.

Thanks to advancements like antibiotics and vaccines, many of the big killers of Minnesotans of yesteryear are preventable or treatable today.

Malarial fevers, a term for summer fevers that were a common killer particularly in the south, are actually what drove the Mayo family to Minnesota in the first place, he said.

Of the then-common illnesses, Fye said, “Most of these, certainly in the U.S., most of these are now preventable or eliminated.”

The tail end of the 19th century was a turning point in modern medicine, Fye said — it was around this time that the medical community was beginning to understand bacteria’s role in causing disease; use of microscopes started to become more widespread. It was around this time, too, that sanitation and public health became more of a concern.

The very existence of the chart speaks to some interest in public health, said Jole Shackelford, an assistant professor in the History of Science, Technology and Medicine program at the University of Minnesota.

“Somebody’s compiling the data for some reason. A physician wouldn’t compile something like this, it’d have to be somebody interested in public health,” he said.

Cities, in particular, made efforts to clean up water and sewage that were cesspools of disease. By the 1930s, because of things like treated water, you already started to see many of these diseases’ prevalence decline, Shackelford said.

Medical professionals also began to realize the importance of sanitary surgery around the turn of the 20th century, Fye said.

But this was still decades pre-penicillin, and the only medicines available were either ineffective, or homeopathic in nature, like digitalis, made from foxglove and used to treat heart conditions.

“Every home had a home medical guide, or two or three of them (that) would talk about basically what plants to grind up … what botanical things might help you,” Fye said.

Another reason the causes of death are so different between 1888 and today is life expectancy. Then, the life expectancy was about 45 years, Fye said. Today, it’s nearly 79, according to the CDC.

Part of why life expectancy was so low 130 years ago was infant mortality — life expectancy is an average, and you had a lot of people dying at very young ages, pulling the number down.

But tuberculosis, childbirth and other diseases killed a lot of young adults, too. Most people didn’t live long past middle age.

“They frankly didn’t live long enough to get degenerative diseases,” Fye said — cancers and heart disease.

Different diagnostics

One big caveat to the 1888 death data is how accurately doctors were able to determine the causes of their patients’ death.

Around 1888, the level of education required to become a doctor would have typically been three years of medical school — no internship and in some cases, no college degree, required, Fye said. That’s compared to more than a decade of education and training for doctors today.

And then there’s the tools. The average doctor would have had a stethoscope, which could help him diagnose audible conditions like pneumonia, Fye said. But this was pre-X-ray, not to mention pre-EKG and pre-MRI, which left doctors to what they could determine based on symptoms or autopsies.

Some of the categories of the diseases on the chart also show how differently we understand disease today, Shackelford said.

The term miasmatic, for instance, which he said goes back to Hippocrates, referred to changes in the air, such as wet to dry or hot to cold. Those changes were thought to have major effects on health at the time.

Today, we know that the diseases shown in that grouping, like diphtheria, scarlatina (scarlet fever), croup and whooping cough are caused by bacteria or viruses, not necessarily air (though the viruses and bacteria could be airborne). In the Victorian era, there were also beliefs about insanity, and hysteria among women, that would never pass medical muster today.

“It’s all changed since then, both the nature of the diseases we’re subject to but also how we think about them was completely changed by laboratory medicine,” Shackelford said.

If there’s one thing this watercolor wheel of death makes clear, it’s that, between the life expectancy discrepancy and the skill of doctors at diagnosing and treating illness, 2018 is a better time to be alive and stay alive than 1888.

“This image is a beautiful one and to the modern eye embodies this transformation in medicine and public health,” Shackelford said.

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Comments (6)

that not only has medical education and treatment moved light-years beyond what was available 130 years ago, but a primary driver of the differences in diseases and lifespan – mentioned, but, in my view, not emphasized enough – is government action, specifically addressing issues surrounding public health.

The turn of the 20th century saw a huge expansion in our scientific knowledge, and that knowledge directly affected government policy at every level from Congress to state legislatures, and right down to your local city or county council or commission. Clean water – still not available in any quantity in some parts of the world – is so widely available and inexpensive that most of us don't even think about it, yet it makes all the difference in the world, and is, quite literally, life-saving. This is why pollution of groundwater is such an important issue.

Pasteurization of milk, laws requiring inoculation before attending school – a prime place for the exchange of germs – and a number of other measures all address the fact, dangerous in this context, that we're social creatures who often gather in large groups, thus making it easy for bacteria and disease to be readily transferred from person to person.

It's interesting to look at these mortality statistics also in terms of deaths per capita, rather than just deaths of one cause per overall deaths. For example, comparing the 1888 category of "accidents and negligence" versus the similar 2016 category of "unintentional injury," if one uses overall deaths as the denominator, as the bar graphs do, it looks like the situation has gotten worse: one is now going to die this way 6.2% of the time versus only 4.8% of the time back then. Is this the result of such factors as greatly increased driving speeds? No. One always dies of something, so this "increase" is just the result of not being as likely to die of TB etc. To see that, one has to look at the per-capita rates. Using the 1890 Minnesota population of 1.31 million, the 720 deaths from accidents and negligence were about 550 per million. In 2016, 6.2% of 43,050 deaths would be about 2,669 due to unintentional injury, which using the 2016 population estimate of 5.52 million translates into 484 per million. So although this is now more likely to be what eventually kills us, it is less likely to kill us in any given year: our world has gotten safer.

Mr. Schooch makes an important point, to which I would add the widespread present-day use of food refrigeration. Food itself presents a mixed picture, with better availability of a variety of good things--citrus fruit, canned and frozen produce, etc--and attractive products that a friend characterizes as "zesty petro snacks, the food-like product with the flavor-like taste."

In Minnesota, across the country, and around the world, doctors, nurses, and average citizens formed "societies" dedicated to fighting tuberculosis. At one international meeting of these anti-TB societies, a doctor likened the group's effort to "a Crusade," and suggested they adopt one of the more familiar symbols carried by the Crusaders -- the Cross of Loraine.

Eventually, many of these organizations merged together and became the American Lung Association, which still uses the double-bared cross as its symbol.

The ALA has shifted it's focus as TB declined and the dangers of tobacco became clearer.